Dr. Stephen Morrell remembers a patient who came to his office only because his parents had insisted.
The man had been mopey and tired, getting little sleep and had absolutely no desire to get off the couch.
“He thought he was just getting out of shape or getting old and just blew it off,” said Dr. Morrell, a family practice physician at Tanner Clinic Kaysville.
That is, until his parents insisted.
The man told Dr. Morrell that he’d had the symptoms for a few months, since he’d been divorced. His parents thought it had been much longer, up to two years.
The patient learned he’d been roughed up and destabilized by depression; he is now working with Dr. Morrell to regain balance in his life.
“But you wonder,”adds Dr. Morrell, “how much depression played into his divorce.”
These days, family medicine doctors are the first line of defense in combating depression. Such patients, said Dr. Morrell, make up a good part of his practice.
Patients trust their family doctors, not the unknown of a psychiatrist. And today’s medicines are tested and effective, said Dr. Morrell. Most depression is treatable, he says, and family doctors “can do a lot of good and take care of the patient before they get to that point where they need to see a psychiatrist.”
Depression is more than ‘feeling sad’
As a society, we’re more aware of depression and its symptoms than ever before. But many people don’t recognize that depression is more than being down in the dumps. Dr. Morrell sees patients who complain of sleeping poorly or losing focus. They’re tired, anxious, feeling guilty; their energy is low and their motivation is zero. These are traits that many patients attribute to laziness or eating poorly. “A lot of times,” he adds, “they’ll come in because someone else has pointed (their behavior) out to them.”
Some depression is the result of a hormonal imbalance or a lack of serotonin. However, the family physician credits much of the increase in depression to outside influences.
People live amid constant stress, he said. They’re trying to make ends meet in a shaky economy. Add to that marital difficulties and the stresses of raising kids, he said, “and it just wears people down over time.”
Dr. Morrell helps talk patients through a prevalent and unspoken perception that a depressed person is weak or simply not trying hard enough.
When an individual is diagnosed with asthma or diabetes, he said, “there’s a legitimacy to that. Patients aren’t embarrassed to talk about it.”
What many don’t understand, he said, is that depression is a physical response, aggravated by hormonal changes, life events, genetics or imbalances in such brain chemicals as neurotransmitters.
Chronic depression ‘under the surface’
Depression often comes down to two types: situational and chronic.
Situational depression is the loss of functionality and motivation caused by traumatic life events. “I see patients who are doing pretty well and on top of things,” said Dr. Morrell, “and then their spouse dies, or their dad dies, and they just spiral out of control.” In these cases, he said, antidepressant medicines can help, but counseling — and passage of time — is often more effective.
Then there’s depression that time doesn’t heal so readily.
Depression in these patients, he said, has been “under the surface for a long time. They either reach a crisis point or a loved one says, ‘You need to see a doctor.’”
Chronic depression, he adds, “starts very insidiously. It’s ‘I have a hard time getting up in the mornings’ or ‘I used to enjoy playing basketball with my buddies.’ Before they know it, they’re knee-deep in it.”
The great majority of depression, situation or chronic, adds Dr. Morrell, can be treated with a visit to a doctor you trust.